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Findings from a prospective cohort study evaluating the effects of International Health Advisors' work on recently settled migrants' health
Susanne Sundell Lecerof ORCID: orcid.org/0000-0002-4762-63801,
Martin Stafström1,
Maria Emmelin1,
Ragnar Westerling2 &
Per-Olof Östergen1
Several interventions have been carried out to tackle health inequalities between migrant groups, especially refugees, and native-born European populations. These initiatives are often address language or cultural barriers. One of them is the International Health Advisors (IHA) in Sweden; a peer education intervention aimed at providing health information for recently settled migrants. It is known that social determinants, such as educational level and access to social capital, affect health. Social determinants may also affect how health information is received and transformed into practice. The aims of this study was to a) assess the impact of the IHA on recently settled migrants' self-reported health status, and received health information; b) determine the moderating role of educational level and social capital; and c) critically discuss the outcomes and suggest implications for health promotion practice.
The study was designed as a prospective cohort study. A postal questionnaire translated to Arabic was sent to recently settled Iraqi migrants in eight counties in Sweden, in May 2008 and May 2010. Two of the counties were exposed to the intervention, and six were used as references.
The proportion of individuals who reported that they had received information on healthy diet and physical exercise was higher in the intervention group than in the non-intervention group (OR 2.31, 95% CI 1.02–5.22), after adjustments. Low social participation was negatively associated with deteriorated or unchanged health needs (OR 0.47, 95% CI 0.24–0.92). No other statistically significant differences in health outcomes could be observed between the groups. No signs of effect modification on this association by social capital or educational level could be found.
Health information provided by the IHA increased self-reported level of knowledge on healthy diet and physical exercise. The interpretation of the observed negative association between low social participation and deteriorated or unchanged health needs is that participation was limited to one's own social group, and therefore had limited positive influence on health seeking behaviour. The lack of measurable improvements in health status could be explained by limitations in the study, in the theoretical assumptions underlying the intervention, and in the implementation of the intervention. Further research is needed to understand success factors in health promoting interventions among recently settled migrants better.
Migrant groups, especially refugees, have poorer health status than native populations in for example Europe and the US. Their self-rated health has been found lower [1,2,3], their mental health poorer [4,5,6,7,8,9,10], and they have a higher proportion of unmet health needs [11]. Previous studies also show lower health literacy rates and lower access to health information [12,13,15]. However, some studies have indicated that these associations can be moderated by educational level [12]. These circumstances threaten health equity irrespective of ethnic background or socioeconomic status.
The described situation poses a challenge to health promotion practice. Barriers to provision of adequate health services and health promotion interventions have been reported in the literature, e.g. language problems, cultural differences and lack of trust [16,17,19]. The term 'migrant' is defined by the International Organization of Migration as: "Any person who is moving or has moved across an international border or within a State away from his/her habitual place of residence, regardless of (1) the person's legal status; (2) whether the movement is voluntary or involuntary; (3) what the causes for the movement are; or (4) what the length of the stay is", and the term 'refugee' is defined by the United Nations Refugee Agency as "Any person who, owing to well-funded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it". Hence, recently settled migrants are a heterogenous group with different socioeconomic backgrounds and differential access to social capital in their daily environment. Given different migration-related factors, together with social determinants, may play important roles for the health development in the new country and for how health interventions are received and transformed into action.
Different strategies have been adopted to address health inequities. One of the most common strategies utilized is to provide health information to specific target groups. Health information is believed to increase knowledge that in turn will help people to make rational and informed health choices. However, this approach has been criticized for making simplistic assumptions about how health is created. Social cognitive theory was developed by the Canadian psychologist Albert Bandura in 1986. Bandura [20] claims that such a strategy does not take into account the social and economic factors that may play a mediating role or affect people's health directly, for example educational level and social capital. Persons with higher educational level seem to find it easier to interpret and adopt information, and to translate it into practice [21]. People with high access social capital, measured as social participation and trust in others [22], have also been shown to have better health outcomes [23]. Social capital is believed to affect health through social interaction or by facilitating stress-buffering [24]. Social interaction can promote positive or negative health-related behaviors through shared norms, whereby belonging to a social network can help individuals access both tangible and intangible resources in times of need. The stress-buffering model suggests that individual's perceived access to practical and/or emotional social support alleviates discomfort under stressful life events, and thereby moderates the individual's emotional and behavioral response to that event (ibid).
In Sweden, several health-promoting interventions have been conducted among recently settled refugees in order to promote health and/or prevent ill health. In this study, we examine a peer-to-peer health information intervention known in Sweden as "International Health Advisors" (henceforth IHA). The IHA are persons with migrant background, who are employed by the county board or county council, and offer their recently settled peers health and health services information in their native language. Some interventions, also targeting migrant groups, have been scientifically evaluated. Ekblad and colleagues [25] found that a group of recently settled Arabic- and Somali-speaking women who received a culturally tailored health promotion intervention carried out by licensed clinicians improved their self-rated health and self-reported level of strength and energy significantly during the intervention. Qualitative interviews indicated that the women felt they had better knowledge and preparedness to manage stress (ibid). Another culturally adapted intervention aimed at reducing diabetes risk through dietary advice, was implemented among Pakistani women in Oslo, Norway. Norwegian project staff did the teaching and led the discussions with the help of interpreters. The study showed that the women improved their knowledge on healthy diet, and increased their intentions to change their dietary habits in order to reduce weight and risk of diabetes [26–28]. However, few scientific evaluations have explored the possible links between health outcomes and social determinants such as educational level and social capital and used a critical public health perspective to discuss the results with the purpose of developing a stronger evidence base.
The overall aim of this study was to assess the impact of an IHA intervention among recently settled Iraqi migrants in Sweden, by determining the change in self-reported health measures in two cohorts over a 2-year period. Contributing to better health among recently settled refugees was one of the goals of the intervention. The specific objectives were therefore to assess the impact of the intervention on self-reported health status, unmet health needs, received health information, and the role of educational level and social capital (defined as social participation or trust in others) in this; and to critically discuss the outcomes and suggest implications for development of practice.
This was a prospective cohort study following Iraqi citizens in eight counties in Sweden of which two received the IHA intervention and the remaining six counties were used as references.
The intervention and its context
In this study we examine a peer-to-peer health information intervention known in Sweden as "International Health Advisors" (IHA). As mentioned before, the IHA are persons with migrant background, who are recruited and employed by the county administrative board or county council, qualified through language skills, communication skills and sometimes with a professional background in health or social care. They receive preparatory training for their special task to provide recently settled refugees with health and health services information in their native language. Further in-service training includes short courses in for example first aid. The themes covered in their information package for recently settled refugees include information about the Swedish health care system, self-care, healthy diet, physical exercise, common conditions like flu or fever and mental health. At the time of data collection, refugees usually met the IHA 1–3 times.
Recently settled refugees in Sweden receive governmental reimbursement during the first 2 years upon resettlement. The labor office is responsible for coordinating activities for the refugees and for those family members who arrive within 2 years after resettlement of the first refugee. All are offered Swedish For Immigrants (SFI), civic information, and labor market introduction, unless they are on parental leave or sick leave. The intervention took place mainly in Swedish for immigrants' classes for targeted groups of recently settled refugees. In the two counties that had access to IHA during the time of data collection, health information was also part of these activities offered for the recently settled refugees. At the time of data collection, the Iraqi migrants were the largest migrant group coming to Sweden, the majority of them as refugees or family reunion cases of refugees, ensuring a sample size large enough. The rationale was to minimize as much as possible the effects of different cultural backgrounds, different reasons for and different time periods of migrating.
Data was collected through a postal questionnaire. The questionnaire was designed in a group of researchers (including the authors) in a project aimed at evaluating and contributing to the improvement the intervention. The community was consulted in a qualitative pilot study.
The questionnaire was translated to Arabic and tested for comprehensibility and cultural appropriateness in focus groups stratified for gender and educational level. After revisions, it was sent out to all adults born in Iraq who were identified as new individuals in the Swedish population register in the counties of Stockholm, Uppsala, Södermanland, Östergötland, Örebro, Västra Götaland, Kronoberg and Skåne during the time period December 1st 2007 – February 28th 2008. At this time, the intervention of IHA was established in the counties of Skåne and Östergötland. The exposed and unexposed counties were similar in degree of urbanization, employment an immigration rates, and the system for receiving recently settled refugees is the same in all counties in Sweden. To our knowledge, there were no systematic factors affecting recently settled refugees' choice of county for resettlement.
The baseline questionnaire was administered in May 2008 and resulted in a response rate of 51% (n = 617/1213). Twenty-nine per cent of the respondents (n = 181/617) resided in the intervention counties and 71% (n = 436/617) in the non-intervention counties. 68% (n = 421) of the persons who answered the baseline questionnaire also answered a follow-up questionnaire in May 2010. Twenty-one per cent (n = 117) of them resided in the intervention counties and 79% (n = 286) in the non-intervention counties.
The study was approved by the Regional board of ethical vetting in Lund (reference numbers 2009/22 and 191/2008),
Variable definitions
The intervention variable was defined by county of residence at baseline and follow-up, assuming that the study subjects who remained residents in the counties of Skåne and Östergötland would, at some point, be exposed to contact with the International Health, and that those residing in the other counties would remain unexposed to the intervention. Those who moved from an intervention county to a reference county, or vice versa, during the study period were omitted from the analyses (n = 18). The reason for choosing this intention-to-treat approach was to attempt making a "real world" evaluation of the intervention, namely to estimate what would most likely be the effect if the interventions was repeated in a new setting, rather than to evaluate the effect only among those selected individuals who were exposed to the intervention activities at a certain level (usually a level which would be likely to have an effect). This means a conservative approach, but we argue that the yielded information is more valuable for those contemplating to implement a similar intervention program.
The outcome variables were unmet health care needs, poor mental health, poor dental health status, poor self-rated health, long-term illness, social capital measured as social participation and trust in others, and received information on diet, physical exercise and dental health. The outcome variables were coded focusing on change, not absolute levels. "Negative change", "no change" and "positive change" represent three values on an ordinal scale, and the variables were dichotomized between "positive change" and the other two variable values on this scale.
Unmet health care needs were measured by asking the question: "Have you ever, during the last 3 months, regarded yourself in need of medical care, but not sought a doctor?". The variable was dichotomized, so that the response alternative "yes, several times", indicating that health needs persisted, was defined as having unmet health care needs, and "yes, once" and "no" were defined as not having unmet health care needs. The values from the dichotomized baseline variable were combined with the dichotomized follow-up variable, creating a single variable with four values signifying change between baseline status and follow-up: "Remained good", "improved", "remained bad" and "deteriorated". The new variable was then dichotomized into two values coded as "Improved" and the other three values as "unchanged or deteriorated".
Mental health was assessed by using the 12-item instrument General Health Questionnaire, GHQ-12, developed by Goldberg and colleagues [29]. The instrument has been translated to several languages, including Arabic [30, 31], and has been found to have a good cross-cultural validity [32, 33]. The 12 items in the instrument were dichotomized so that values indicating symptoms of poor mental health "as usual" or "more than usual" was coded as 1, and "less than usual" or "a lot less than usual" was coded as 0. The dichotomized variables were then added to each other so that a scale rendering 0–12 points was created. The mean of the distribution of the points in the sample was 2.65, and the cutoff point was set between two and three when the point scale was dichotomized. This cutoff was similar to that applied by other studies [32]. Poor mental health was defined as having three points or more on the scale. The baseline and follow-up variables were combined in a new variable signifying change between baseline and follow-up, which was coded with the values "improved", "remained good", "remained bad" and "deteriorated". Finally, the combined variable was dichotomized in the same way as the previous change variable.
Dental health was measured by asking the respondents to rate their dental health on a Likert scale with five values; "Very good", "Quite good", "Neither good nor poor", "Quite poor" and "Very poor". The baseline and the follow-up variables were dichotomized, so that those who rated their dental health as "quite poor" or "very poor" were defined as having poor dental health, and the others as having good dental health. A change variable was constructed, coded and dichotomized in the same way as for the previous outcomes.
Similarly, self-rated health was assessed with a single question: "How would you currently assess your general health?" – requiring the respondents to rate their current general health status on a Likert scale with five values; "Very good", "Quite good", "Neither good nor poor", "Quite poor" and "Very poor". The baseline and follow-up variables were dichotomized so that "Quite poor" or "very poor" were defined as poor self-rated health, and the other values as good self-rated health. This instrument has demonstrated good predictive value when it comes to actual morbidity and mortality [34, 35]. The change variable was then developed in the same way as the previous outcome variables.
Long-term illness was defined as having answered "yes" to the question "Do you have any lingering illness, difficulties following an accident, disability or other frailty. The baseline and follow-up variables were transformed into a change variable similarly as the previous outcome variables.
Social participation, a component of social capital, was assessed using the question "How often do you attend a meeting or another activity in any organization or group (for example sports organization, interest organization, mosque or church, women's or men's group)? The scale was used in the Malmo Diet and Cancer Study [36] Both the baseline and the follow-up variable was dichotomized, so that reporting less often than monthly was defined as low social participation, and the other values as having high social participation, indicating social participation on a regular basis. The dichotomized baseline and follow-up variables were combined, constituting a change variable that was also dichotomized in the same way as the other outcome variables.
Trust in others, another component of social capital, was assessed by combining four variables which measured horizontal trust: "Take a stand on the following statements: a) Most people would use you if they got the chance b) Most people essentially try to be fair c) You can trust most people and d) You cannot be careful enough when you deal with other people". The response alternatives were "Do not agree at all (0 points)", "Do not agree (1 point)", "Agree (2 points)", "Completely agree (3 points)". The second and the third variable were recoded in order to make the scales go in the same direction, with higher values indicating lower trust. The combined scale was dichotomized at the 75th percentile of the distribution of points in the sample. Seven points or more on the scale was defined as low trust in others. A change variable, made up from the baseline and the follow-up values, was constructed and then dichotomized in the same way as all the previously described ones.
The three variables received information on healthy diet, received information on physical exercise and received information on dental health were measured by asking the respondents "Have you received information on healthy diet/physical exercise/dental health?" (three different questions) and the response alternatives were "Yes, a lot", "Yes, quite much", "Yes, a little" and "No". For the regression analyses, we constructed a combined change variable by combining the baseline and follow-up variables information on healthy diet and information on physical exercise, so that the responses created an index of 16 different combinations of the values. They were combined using the same logic as when constructing a measurement ("scale") consisting of more than one item, which measures similar, but not identical, aspects of an underlying concept such as work stress or alcohol addiction. This resulted in a better precision of the underlying concept which could be labelled "health education on healthy lifestyles related to increased risk for overweight/obesity". We then dichotomized this new variable into a response category, which corresponded to having received information on at least one of the topics healthy diet and physical exercise during the study period, and a group which was made up by all other persons in the sample. Similarly, the change variable for baseline and follow-up information on dental health was dichotomized into a response category which meant that the individual had received information during the study period, and a group consisting of all other individuals in the sample.
The variables we adjusted for in analyses were age, gender and educational level. The variables gender and age were derived from the Swedish population register. Educational level was measured by asking the question "What education do you have", with the response alternatives "none", "1–6 years", "7–9 years", "10–12 years", "academic education (university, college)" and "other education, what?". "Other education" was a mixed category of which a majority consisted of persons with higher academic degrees or vocational training, and was therefore recoded to "High level of education", together with those who reported at least 10 years of education. Seven to nine years of education or less was defined as low educational level.
Data were analyzed with the statistics software package IBM SPSS Statistics 22®. We calculated frequencies and percentages of basic sociodemographic characteristics of the sample, for all, and stratified by intervention and non-intervention counties. We also calculated the p-value of within-group differences for health outcomes, health information and determinants, between baseline and follow-up using McNemar's test, set at the 95% significance level. We then performed logistic regression analyses to calculate crude odds ratios and 95% confidence intervals for health outcomes and health information by the different determinants. We also analyzed the between-group differences for the variables that were statistically significant in the binary analyses, using multivariate logistic regression. Finally, we performed analyses of effect modification by social capital (social participation and trust in others) on the associations that were statistically significant in the binary analyses.
Our sample consisted of 403 persons, of which 167 (41.4%) were men (Table 1). The distribution of the genders was very similar in the intervention (n = 117) and the non-intervention group (n = 286). Mean age was 37.2 in the intervention group and 38.1 in the non-intervention group. The intervention group had a larger proportion of persons in the age group 31–45 (48.7%) than the non-intervention group (45.1), whereas the non-intervention group had a larger share of persons aged 46 and over (27.4%) than the intervention group (18.8%). Low educational level was more common in the intervention group (35.7%) than in the non-intervention group (27.4%).
Table 1 Comparison of the distribution of sociodemographic variables, health outcomes and health information at baseline between intervention and non-intervention area
The proportion of respondents who reported unmet health needs and unmet dental health needs had decreased between baseline and follow-up in both the intervention group and the non-intervention group (Table 2). However, the decrease was not statistically significant, but for the unmet health needs in the non-intervention group it just fell short of this (p = 0.06). When the change between baseline and follow-up was assessed for all respondents, without stratification by intervention area, it was statistically significant (p = 0.01). Only small, not statistically significant, changes could be seen for self-reported health status outcomes, social participation and trust in others. The proportion of respondents who reported not having received health information on health diet, physical activity and dental health decreased between baseline and follow-up. The changes in proportion of persons who reported not having received information on healthy diet (p = 0.02), physical exercise (p = 0.004) and dental health (p = 0.00) were all statistically significant in the intervention group. In the non-intervention group, only the change in proportion of respondents who had not received information on dental health was statistically significant (p < 0.001).
Table 2 Comparisons of change in prevalences of health outcomes and health determinants between baseline and followup, and between intervention and non-intervention area
In order to assess the change between baseline and follow-up further, we analyzed the relationships between change between baseline value and follow-up value in the outcome variables on one side and intervention status, educational level and social capital at baseline on the other (Table 3). We found statistically significant associations between not having received information on healthy diet and physical activity and living in a non-intervention area (OR 2.41, 95% CI 1.09–5.33). Low social participation was negatively associated with deteriorated or unchanged unmet health care needs (OR 0.48, 95% CI 0.25–0.92), i.e. individuals with low social participation had a lower risk to increase their unmet health care needs. These associations remained statistically significant after adjustments for gender, age, and educational level (OR 2.31, 95% CI 1.02–5.22 and OR 0.47, 95% CI 0.24–0.92, respectively, Table 4).
Table 3 Crude odds ratios (OR) and 95% confidence intervals (CI) for unchanged or deteriorated health outcomes and health information between intervention and non-intervention area, and regarding educational level and social capital at baseline
Table 4 Risk of not receiving information on healthy diet and physical exercise in non-intervention areas (a) and risk of not improving status of unmet health needs among persons with low social participation (b). Adjusted odds ratios (OR) and 95% confidence intervals (CI)
We also analyzed possible effect modifications by social participation, social trust (social capital) and educational level on the associations between exposure to intervention and having received information on healthy diet and physical exercise, and the effect modification by educational level on the association between high social participation and unmet health care needs. None of these exposure combinations were significantly associated with the outcomes, hence there were no indications of effect modification by social participation, social trust (social capital) or educational level.
The evaluation of the health information intervention given to Iraqi refugees who had settled in Sweden by a special cadre of health educators with immigrant background themselves, showed that the proportion of individuals who reported unchanged or deteriorated status concerning self-rated health, mental health, or unmet health needs did not differ significantly between the intervention and non-intervention area. However, we found a statistically significant difference between the intervention and non-intervention area regarding the proportion of individuals that reported that they had received information increased between baseline and follow-up, was higher in the intervention group.
These findings suggest that the intervention of International health advisors has been successful in providing information on healthy diet and physical exercise in the intervention counties, but not in improving health outcomes. Even though the aim of the intervention was to prevent poor health, in hindsight it does not seem realistic that an intervention based only on a modest dose of information should have a significant impact on health status of the target group given the fairly short time between baseline and follow-up. Our previous research [37] has shown that alternative circumstances, like socioeconomic factors and experience of discrimination, seem to be the most important determinants for the health outcomes in the intervention group. However, the observed increase in knowledge in the intervention group regarding diet and physical activity may, if translated into practice, prevent deterioration of health in the future. This would be important, especially since previous studies have shown that immigrant groups in high-income countries are particularly vulnerable to obesity, diabetes and cardiovascular disease [38–41].
We also analyzed to what extent social capital was a factor of importance for becoming more informed about health issues, regardless of belonging to the intervention group or not. Social participation and trust are seen as important components of social capital [22]. A potential strategy for health promotion practice could be for example fostering civic engagement in neighborhoods [42]. The hypothesis, to be tested in future studies, is that targeted health information encouraging the target group to become more active in participation in society, which in the long run will build trust in others. Subsequently the target group gains better access to health services and supportive systems that is expected to affect health in a positive way. Recently settled migrants generally have weak social networks and it takes time to build up social capital, especially outside one's own group. No positive health effects or effect modification by the social capital variables included were observed in our study. In fact high social participation had a negative effect on unmet health needs. A potential explanation for this is that recently settled migrants mainly have access to bonding social capital, through participating in networks consisting of people with similar social characteristics [43]. Bonding social capital is suggested to not only have health benefits since it actually may limit personal freedom and choice [44]. Bonding social capital may perhaps also have a negative effect on unmet health care needs if people in bonding networks consult and trust their own networks more than the institutionalized health care.
In evaluations of interventions there are commonly two types of errors. First, that the theoretical assumptions of the intervention are erroneous. Secondly, that the implementation fails to carry out the intended intervention. Regarding the first error, health inequities between migrant groups and host populations have been addressed in intervention research before, but often with a more narrow focus on a particular health behavior or outcome than that of IHA. Information is not a sufficient strategy for changing health behaviors or outcomes, as the mechanism for change includes more cognitive and environmental variables than just knowledge alteration [45]. Hence, a tailored intervention needs to be adapted to its target group in more ways than linguistically and culturally. This can be done by carrying out a thorough target group analysis (including assessment of health beliefs, health literacy and environmental factors that enable or constrain healthy choices) with a participatory approach, to guide further steps in planning an intervention. Health needs and causal mechanisms need to be established. A participatory approach would enable empowerment through opportunities to influence decision making processes, and to establish ownership of the intervention to make it sustainable. A participatory approach is also required in definition of aim and setting up feasible goals, and in choosing appropriate method and medium.
Regarding the potential implementation error, research has shown that evaluations of implementations should investigate phenomena such as fidelity, dose delivered, dose received, reach, recruitment and context [46]. The lack of measurable health effects by the IHA intervention might be explained by limitations regarding some of these criteria. First, the fidelity of the International Health Advisors' work towards training in the programme, was challenged by the recruitment and reach of the target population. A qualitative study performed within the same research project as the one reported here, indicated that the target group did not always understand that they were part of a specific intervention [47]. This was confirmed by data in our survey, where only 42 persons (37%) in the intervention counties reported that they had met IHA. A possible interpretation of this finding is that the IHA failed to reach the whole target group, for example those who did not attend classes in Swedish for immigrants (25%, n = 35 in the intervention group, see Table 1). Dose delivered has been documented in the IHA s' office, but dose received was not tracked for individuals. Out of those who participated in our survey, only 34 individuals (26%) in the intervention counties reported they had received health information more than once, and the most common subjects they had received information on were the Swedish health care system and self-care for common illnesses, for example colds. Reported contextual factors which may have influenced the reach and fulfillment of the IHA s' goals could be the change in Swedish establishment policy in 2008, where health information for recently settled migrants was downplayed in favor of civic information. This resulted in a re-organization of how resettlement activities are planned and of actors responsible for implementing them.
The results of this study should be regarded in the light of its limitations.
Selection bias is a possible source of error, as the follow-up response rate was only 68%. At baseline, we found no systematic differences in participation between the genders or between age groups [13]. We assessed the dropouts at follow-up and found that more men than women, more younger than older individuals, and more individuals with low educational level than individuals with high educational level dropped out in the non-intervention group. The composition of the intervention group remained more stable. Studies have suggested that high dropout rates do not necessarily affect outcomes in any significant direction [48], but the risk cannot be completely ruled out. Research findings also show that socioeconomically disadvantaged persons are more prone to dropout from studies compared to those with a higher socioeconomic status.
Misclassification is another potential bias in this study. A non-differential misclassification of both exposed and unexposed individuals could have been the result of high mobility of the group and time lag in the register. In this case, the results may have been underestimated. However, we reduced this risk by omitting those who moved between the exposed and unexposed areas during the time period of the study, from the analysis.
Confounding could have flawed the findings of this study. However, some of this risk should have been controlled for in analyses adjusted for common social determinants (Tables 3 and 4).
The main contribution of this article is the finding that an intervention based on provision of health information increased self-reported level of knowledge of healthy diet and physical exercise during the 2-year follow-up period. However, no statistically significant improvements in health status associated with the intervention could be measured in this study. This could be explained by limitations in the study, limitations in the theoretical assumptions underlying the intervention, and limitations in the implementation of the intervention. Poor health status remains a pertinent issue 2 years after refugee resettlement, and should be addressed more systematically. Further research is needed in order to understand health promoting factors better among recently settled migrants.
GHQ:
General Health Questionnaire
IHA:
International Health Advisors
SFI:
Swedish for immigrants
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Putnam RD. Bowling alone : the collapse and revival of American community. New York: Simon & Schuster; 2000.
Kawachi I, Kim D, Subramanian SV, SpringerLink (Online service). Social capital and health. New York: Springer Science + Business Media, LLC; 2008.
Kawachi I, Berkman LF. Social ties and mental health. J Urban Health. 2001;78(3):458–67.
Ekblad S, Persson-Valenzuela UB. Lifestyle Course as an Investment in Perceived Improved Health among Newly Arrived Women from Countries outside Europe. Int J Environ Res Public Health. 2014;11(10):10622–40.
Raberg Kjollesdal MK, Hjellset VT, Bjorge B, Holmboe-Ottesen G, Wandel M. Food perceptions in terms of health among Norwegian-Pakistani women participating in a culturally adapted intervention. Int J Public Health. 2011;56(5):475–83.
Raberg Kjollesdal MK, Hjellset VT, Bjorge B, Holmboe-Ottesen G, Wandel M. Intention to change dietary habits, and weight loss among Norwegian-Pakistani women participating in a culturally adapted intervention. J Immigr Minor Health. 2011;13(6):1150–8.
Raberg Kjollesdal MK, Holmboe-Ottesen G, Wandel M. Does the "stages of change" construct predict cross-sectional and temporal variations in dietary behavior and selected indicators of diabetes risk among Norwegian-Pakistani women? J Immigr Minor Health. 2013;15(1):85–92.
Goldberg D. GHQ and psychiatric case. Br J Psychiatry. 1979;134:446–7.
Daradkeh TK, Ghubash R, el-rufaie OE. Reliability, validity, and factor structure of the Arabic version of the 12-item General Health Questionnaire. Psychol Rep. 2001;89(1):85–94.
el-Rufaie OF, Daradkeh TK. Validation of the Arabic versions of the thirty- and twelve-item General Health Questionnaires in primary care patients. Br J Psychiatry. 1996;169(5):662–4.
Werneke U, Goldberg DP, Yalcin I, Ustun BT. The stability of the factor structure of the General Health Questionnaire. Psychol Med. 2000;30(4):823–9.
Goldberg DP, Oldehinkel T, Ormel J. Why GHQ threshold varies from one place to another. Psychol Med. 1998;28(4):915–21.
DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P. Mortality prediction with a single general self-rated health question. A meta-analysis. J Gen Intern Med. 2006;21(3):267–75.
Mavaddat N, Parker RA, Sanderson S, Mant J, Kinmonth AL. Relationship of self-rated health with fatal and non-fatal outcomes in cardiovascular disease: a systematic review and meta-analysis. PLoS One. 2014;9(7):e103509.
Lindström M, Hanson BS, Ostergren PO. Socioeconomic differences in leisure-time physical activity: the role of social participation and social capital in shaping health related behaviour. Soc Sci Med. 2001;52:441–1.
Lecerof SS, Stafstrom M, Westerling R, Ostergren PO. Does social capital protect mental health among migrants in Sweden? Health Promotion International. 2016;31(3):644–52.
Gadd M, Johansson SE, Sundquist J, Wandell P. Morbidity in cardiovascular diseases in immigrants in Sweden. J Intern Med. 2003;254(3):236–43.
Gadd M, Johansson SE, Sundquist J, Wandell P. The trend of cardiovascular disease in immigrants in Sweden. Eur J Epidemiol. 2005;20(9):755–60.
Gadd M, Sundquist J, Johansson SE, Wandell P. Do immigrants have an increased prevalence of unhealthy behaviours and risk factors for coronary heart disease? Eur J Cardiovasc Prev Rehabil. 2005;12(6):535–41.
Gadd MJ, S-E, Sundquist J, Wändell P. Morbidity in cardiovascular diseases in immigrants in Sweden. J Intern Med. 2005;254:236–43.
Eriksson M. Social Capital, Health and Community Action – Implications for Health Promotion, Medical dissertation. Umeå: Umeå University; 2010.
Harpham T, Grant E, Rodriguez C. Mental health and social capital in Cali, Colombia. Soc Sci Med. 2004;58(11):2267–77.
Uslaner EM, Conley RS. Civic engagement and particularized trust – The ties that bind people to their ethnic communities. Am Polit Res. 2003;31(4):331–60.
Bandura A. Health Promotion by Social Cognitive Means. Health Educ Behav. 2004;31(2):143–64.
Saunders RP, Evans MH, Joshi P. Developing a process-evaluation plan for assessing health promotion program implementation: a how-to guide. Health Promot Pract. 2005;6(2):134–47.
Sundell Lecerof S, Stafström M. Olika villkor – olika hälsa. En osynlig intervention? Malmö: Lunds Universitet, Malmö högskola; 2011. https://www.mah.se/upload/Forskningscentrum/MIM/IMHAd/En%20osynlig%20intervention.pdf. Accessed 3 Sept 2015
Carlsson F, Merlo J, Lindström M, Östergren P-O, Lithman T. Representativity of a Postal Public Health Questionnaire Survey in Sweden, with Special Reference to Ethnic Differences in Participation. Scand J Public Health. 2006;34:132–9.
The study was funded by grants from the European Refugee Fund and partners in the research project IMHAd (Impact of Multicultural Health Advisors). We thank professor emeritus Björn Fryklund and professor Pieter Bevelander at Malmö Institute for Studies of Migration, Diversity, and Welfare at Malmö University for hosting the project and kindly inviting us to research seminars where important critical discussions were held.
The intervention study was funded by grants from the European Refugee Fund and partners in the research project IMHAd (Impact of Multicultural Health Advisors). The study was co-funded for evaluation purposes by some of the stakeholders of the intervention (Regionförbundet Östsam, Kinda kommun, Region Skåne and Malmö stad).
The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.
SSL, RW and POÖ planned and designed the survey. SSL designed the study and performed the statistical analyses under critical revision of MS, RW and POÖ. SSL, MS, RW, ME and POÖ participated in the interpretation of data and SSL drafted the manuscript. MS, RW, ME and POÖ contributed important intellectual content to the manuscript. All authors read and approved the final manuscript.
The study was approved by the Regional board of ethical vetting in Lund (reference numbers 2009/22 and 191/2008). The purpose of the study, voluntary participation, possibility to withdraw one's participation, and confidentiality were explained in a cover letter in Arabic and Swedish. The cover letter also had information on planned publication for research purposes and that no individual data was going to be presented. Queries relating to the survey were invited and the names and contact details were given to one Swedish-speaking researcher and one Arabic-speaking assistant. The participants consented to participate in the study by answering the postal questionnaire.
Social Medicine and Global Health, Department of Clinical Sciences Malmoe, Lund University, Clinical Research Centre, Jan Waldenstroms gata 35, 205 02, Malmoe, Sweden
Susanne Sundell Lecerof, Martin Stafström, Maria Emmelin & Per-Olof Östergen
Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden
Ragnar Westerling
Susanne Sundell Lecerof
Martin Stafström
Maria Emmelin
Per-Olof Östergen
Correspondence to Susanne Sundell Lecerof.
Table 5 Variable definitions/items in the questionnaire
Lecerof, S.S., Stafström, M., Emmelin, M. et al. Findings from a prospective cohort study evaluating the effects of International Health Advisors' work on recently settled migrants' health. BMC Public Health 17, 369 (2017). https://doi.org/10.1186/s12889-017-4273-0


The State Bar of Georgia recognized recently retired Georgia State Law professor Roy Sobelson's service to legal education and the justice system during its annual meeting in June.
"This resolution expresses our appreciation to Professor Roy Sobelson for his many contributions, which will have a lasting, positive impact on the legal profession and the justice system of this state," said Brian D. "Buck" Rogers, 2017-18 State Bar president.
"It's a little embarrassing to be honest, but I appreciate it," Sobelson said, who describes his career as rather serendipitous with one thing leading to another. Or, as a friend noted, his career might just be the result of Sobelson always replying "yes" when asked to do something.
Joining the Georgia State Law faculty in 1985, Sobelson has served as professor of law, associate dean for academic affairs and director of the LL.M. program. He has been involved continually with the State Bar, which began when Sobelson was asked to audit the disciplinary counsel and to train lawyers in that office in litigation and ethics.
Early on, he was asked by a Supreme Court Justice to be a special master, agreeing before finding out how difficult the case would be. He's been a reporter for several commissions, including one studying rules allowing lawyers trained in other countries to practice here, valuable experience for Georgia State Law when creating its LL.M. program.
One of the things of which he is most proud is the process he instituted at Georgia State Law, now used statewide, for ensuring students are truthful, especially about any criminal record, on law school applications.
Some violations are so serious that, if the student is candid on the application, admission would be denied. At the point of applying for the bar exam, students realize they must be honest. But in doing so, they risk being refused.
Now at orientation, Sobelson or the current associate dean for academic affairs guides students through the two-page document he developed, giving them another opportunity to answer questions truthfully. They must sign the document in his or the associate dean for academic affairs' presence.
The cameras found them. They appeared on the big screen. "He was over the moon," Sobelson said.


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Animated / Film Composers / Film Scores / News / Releases / Soundtracks
GAMBA – Original Motion Picture Soundtrack
by Kinetophone on Oct 7, 2015 • 3:46 pm No Comments
Music Composed By BENJAMIN WALLFISCH
Varèse Sarabande will release the GAMBA – Original Motion Picture Soundtrack digitally on October 9, 2015 and on CD in 2016. The album features the film's original score composed by Benjamin Wallfisch (DESERT DANCER, THE ESCAPIST). This animated film is based on the beloved Japanese children's book The Adventures of Gamba.
"Even though this is a children's movie, there are some moments of real tragedy in the story, followed by plot shifts which are quite deeply rooted in Japanese traditions," Wallfisch described. "The idea that you must avenge the death of a loved one, a friend or simply someone who loses their life fighting for a cause you share."
Gamba, a town mouse with a brave, adventurous spirit decides to go on an adventure to discover the ocean. On his way, he meets a troubled child mouse, Chuta. He says his family and other mice have been killed by a clan of weasels living on a nearby island. Chuta asks a group of ship mice, the bravest of their kind, for help, but when they find out that the villain behind this event is the terrifying weasel-leader Noroi, they give up on helping Chuta. However seeing the hopeless Chuta, Gamba promises him to save the island, his family and the other mice. Gamba and his friends team up to go on their adventure to defeat the evil Noroi and his clan.
"There are so many layers to Gamba's story, but the one thing that is consistent throughout is the sense of a child's wonder at the world, and that anything is possible," Wallfisch explained. "His personality is larger than life, and it was important to the director that the score helped reflect that; but at the same time there is a fragility to his character – he is only really as strong as the friends he has around him. Once you go beneath the surface of the story you find strong messages of hope in the face of adversity, all in the context of a faced-paced, visually stunning and often action-led movie."
Benjamin Wallfisch is an EMMY® and multiple Ivor Novello nominated composer who has worked on 52 movies to-date. He made his scoring debut at the age of 24, composing the music for Thomas Vinterberg's DEAR WENDY (World Soundtrack Awards 'Discovery of the Year' nominee & Danish Film Academy Awards nominee for 'Best Original Score').
Wallfisch composed, orchestrated and conducted the suspense thriller THE ESCAPIST (Ivor Novello Awards nominee & World Soundtrack Awards 'Discovery of the Year' nominee). Recent scoring projects include DESERT DANCER (soundtrack released earlier this year on Varèse Sarabande), HOURS, SUMMER IN FEBRUARY, HAMMER OF THE GODS, THE THIRTEENTH TALE, BHOPAL: A PRAYER FOR RAIN, PRESSURE and additional music for TWELVE YEARS A SLAVE. He orchestrated and conducted the Oscar® winning score for ATONEMENT and upcoming scoring projects include the features BITTER HARVEST, A FLICKERING TRUTH, MULLY and WITHIN for New Line Cinema.
Earlier this year he composed the original score for the Steven Spielberg produced short film AUSCHWITZ, directed by James Moll, and was invited by Academy Award winning composer Hans Zimmer to collaborate on the arrangement of the Grammy performance of 'Happy' by Pharrell Williams.
"Though GAMBA is well-known in Japan, the story is hardly known in the West," said Wallfisch. "The director and producers were keen the movie has a universal appeal. This helped me make the decision not to use any Japanese instruments in the score (except for one ritualistic scene with onscreen music) – the score focuses on the universal messages of the film, through the medium of a large orchestra."
Shirogumi Inc. presents GAMBA, in theaters in Japan on October 10 and in the United States in early 2016. The GAMBA – Original Motion Picture Soundtrack will be available digitally on October 9, and on CD in 2016.
1. Gamba's World (3:33)
2. Party Mice (1:48)
3. Boss Fight (2:01)
4. The Clan of Noroi (2:24)
5. Stronger Together (3:50)
6. The Map (1:34)
7. Sunrise (1:47)
8. Exploring The Island (1:17)
9. You Can't Defeat Noroi (1:32)
10. Shioji (2:17)
11. First Fight (1:22)
12. The Plan (3:46)
13. The Weasels Have Come (1:53)
14. Goodbye (1:15)
15. Island Battle (4:14)
16. Hope (2:35)
17. That's It (2:05)
18. The Water Changes (3:02)
19. Death Of Bobo (2:18)
20. Gamba Fights Noroi (6:30)
21. Noroi Returns (6:48)
22. Victory (4:25)
Tags: 2015, Animated, Benjamin Wallfisch, Film Composers, Film Scores, Gamba, News, Releases, Soundtracks, Varese Sarabande
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redpajama_set_name: RedPajamaCommonCrawl


text:
Q: Is there a Todd-Coxeter algorithm for rings? The question above.

A: Sort of yes, because there is a better algorithm for rings, known under umbrella name of Grobner Basis. It works the nicest for commutative algebras, but there are various versions for algebras over Euclidian domains, associative algebras, Lie algebras etc. What is the ring you are after?

A: Yes, this is implemented as the Vector Enumeration in magma:
http://magma.maths.usyd.edu.au/magma/htmlhelp/text942.htm#9432
This is also included in GAP.
http://www.math.jussieu.fr/~jmichel/gap3/htm/chap065.htm

redpajama_set_name: RedPajamaStackExchange


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Office Space - Pine Brook, New Jersey.
Executive offices with plush furnishings available in this centre. This centre is close to the I-280. Comes equipped with the latest technology and offers an exclusive business location. Many administrative and postal facilities offered. Free parking available.


Staff Selection Commission - Combined Graduate Level Examination, often referred to as SSC CGL is an exam conducted to recruit staffs to various posts in ministries, departments, and organizations of the Government of India. SSC exam is conducted by the Staff Selection Commission for selecting staff for various Group B and Group C posts. SSC is one of the leading job providing body of India and recruits candidates to various reputed jobs like Inspector of Income Tax, Inspector in CBEC, Sub-inspector CBI , Asst. Enforcement Officer and many moreThe candidates applying for SSC should be a graduate from any reputed university of India. The SSC CGL exam will be conducted in various tiers and modes. Each and every year the demand for the government jobs is increasing among the candidates. SSC releases the job notifications of SSC CGL in the first half of the year and the examinations are held under the guidance and observations of SSC. We know how to help the students to crack these exams and offer you with all the tricks and trades which make easier for our students to perform better at various SSC exams like SSC CGL, SSC CHSL, SSC MTS, SSC CPO and SSC JE conducted throughout the country. Himalayan Classes with its headquarters in Patna have various batches of SSC CGL running in different time slots which includes batches from 8 am in the morning to as late as 9 pm in evening and weekend batches for working professionals.For the time of various batches at various centers, please visit our website: himalayanclasses.com In the best of your interest, we would advise you to come and visit our centres for detailed information from our dedicated counselors. Our information brochure extensively covers the various job exams, syllabus, eligibility, and other details. You can also attend demo classes for a better insight of the SSC CGL exams. Come to us and be exam ready for SSC CGL exams. Looking forward to seeing you at Himalayan Classes.


Yesterday night I was taken aback by the news of Arjan Singh passing away to cardiac arrest. I mean it was just weeks back when we saw him at the Rashtrapati Bhawan during the induction and swearing in ceremony of His Excellancy Ram Nath Kovind.
Marshall of Air Force Arjan Singh (98), who was also the last surviving 5 star rank officer (apart from Field Marshalls Sam Manekshaw and K.M Cariappa). Commissioned in 1939 he was from one of the first batches of native Inidan Officers to fly Spitfires of RAF in WW2. He was also the last surviving Indian officer, who was a combat fighter pilot in WW2, also won Distinguished Flying Cross in Arakan Campaign (1943).
On 15th August 1947 he led a squadron which flew it's formations over Red Fort.
Post independence he played an important role in setting up the early phase of IAF. In 1965, he became Air Chief Marshall only at 45 years, which is still the youngest for any 4 star rank Officer across all three wings of Armed Forces of India. The 1965 Indo Pak War saw first time full scale deployment of the Indian Air Force and Arjan Singh played the pivotal role, shepherding IAF as the erstwhile Air Chief Marshall.
Going by various neutral sources and post war assessment tribunals, IAF sorties accounted for greater kills over PAF head to head, despite subsonic Folland Gnat and Hawker Hunters being inferior n outdated to transonic F86 Sabres. Thus hadn't it been for the IAF's hawk eyed vigil & kill under the marshalling of Air Marshall Arjan Singh, Pakistan's Defence Day (6th September) wouldn't have been a figment of fictional hoax.
Post war he held the post for 5 years, which is till date longest serving tenure of an Air Marshall and retired in 1970, at the age of 50.
Post retirement, he became a diplomat and served as India's Ambassador to Switzerland & Vatican, High Commissioner to Kenya and also was Delhi's Lt. Governor.
All of these incidents happened before i was born. So reading and writing about these facts are simple narration of historical facts, anecdotes and events. But the incident which left an indelible mark in my memory was the one which unfolded on the morning of 27th July 2015 at Palam air base. Here we had the corpse of our Greatest people's President (83) resting in his coffin, and a functionally paraplegic wheelchair bound geriatric, thirteen years senior to late Prez, pulled a la' Carl Brashear (Men of Honour) i.e. "to Stand up by the wheelchair and Walk" to pay homage and respect to Abdul Kalam. That was indeed a surreal moment and remembering and writing about it still gives me goosebumps. This will go down as one of the most powerful yet poignant images of the Twenty First Century.


I think this essay is important reading for designers, as we are the ones who are often sought after for producing guidance for others. We design, designate, and guide behaviour and thinking of others, producing frictionless paths of action for our consumers or users. We are hired by our agents to make sure people stay immature, that the stay dependent on us and perpetually guided towards an addiction to the commodity economy. The autonomy of thinking sought by Kant should today perhaps be complemented with autonomy of action: to be enlightened within the realm of contemporary design is to have the resolve and courage to act beyond what is proposed or designated for us, at least to step beyond the design we meet within the everyday "user-friendly" market.
People in general may understand that the conditions of the world are not heading towards a brighter future: injustices are growing, people are jailed without proper trials or both the market and the state propels a general culture of fear. Like Kant says, it is not knowledge or understanding that is missing, but a lack in resolve and courage to act and hold people in power responsible. Most of us are cowards as much as we are lazy. I guess Kant would say we let our enlightenment be robbed from us.
And perhaps we as designers have more blame than we may think. It is the role of design to keep the general public fearful and lazy: fearful of loosing the convenience of our possessions and making sure consumer society stays "user friendly" with minimum friction, so that any form of alternative action seems dangerous and inconvenient. We design to make sure users stay anxious and passive.
Jean-Jacques Rousseau famously claimed in his essay "The Social Contract" that man is born free but everywhere in chains. Today we are born free, but everywhere in chain-stores. Still living in self-imposed immaturity, design makes sure we stay guided by fear.
But we can see people who are disobedient and courageous out there, reckless and free-thinking. But it is a little scary that throughout the everyday the encounter with fellow citizens is guided externally by the convenience of design, and its opposite, by fear. Fear contracts the spirit, it turns us into narcissist egotists. It becomes impossible for us to form any compassion or reason. And even a lot of the counter movements, such as Open Design, Do-It-Yourself or socially engaged practices, still pushes us into that individualist, frictionless and fearful direction. As we put our spotlight on the self, the consumer or user, we simultaneously cast other lives and ideals into darkness. We fail to stand up for common goods, for justice and for the courage and inconvenience to do the right thing.
According to Kant, it is laziness and cowardice that are the main reasons why people remains dependent on external guidance. Our first move must be to challenge our own fear and dare to think of the inconvenient, the non-user-friendliness that is the quest for justice, for the virtuous and righteous.
Don't be lazy. Don't be a coward. Take action. Design must start to know itself. It must know itself in order to open up outside of itself. To serve justice and to promote peace and civic friendship. A real friendship: inconvenient and costly as it may be.
Dare to act! Have courage to use your own agency! – that should be the motto of the design enlightenment.


Announcer: In Moscow a worldwide three months propaganda effort was climaxed in a public trial. Caught in the power play was Francis Gary Powers, pilot of the U-2 aircraft downed by Soviet rockets.
Powers who's confession came after an unprecedented admission by the American government of spy in the sky tactics, repeated the self-damning words in the Moscow courtroom jammed with spectators from all over the world including his wife and parents.
Unknown Speaker: "Leaving Moscow the flight trial in Moscow today the defendant Powers made his final fleet."
Francis Gary Powers: "I realize that I have committed a grave crime and I realize that I must be punished for it. I have oath to way all the evidence and take into consideration not only the facts that I committed at times but also the circumstances which led me to do so. And I would like to stretch the fact that I do not feel nor have I ever felt any enmity whatsoever for the Russian people."
Announcer: The pilot's father, Oliver Powers of Pound Ridge Virginia spoke with reporters upon arrival home from Moscow. After his son was sentenced to ten years in a Russian prison.
Unknown Speaker: "What did he want most from you and from his mother in terms of things from home or things you could do for him?"
Oliver Powers: "He didn't ask us for anything specific, he said he needed warm clothing for winter."


While the cult sitcom about the wacky Bluth family returns on Netflix this Sunday for a 15-episode run, Netflix chief Ted Sarandos says more episodes are possible.
"We would love to do more, and we have a deal in place that says that there could be [more]," Sarandos told the Hollywood Reporter.
"Arrested," which last aired on Fox in 2006, is returning with its entire core cast intact — but that could also make more episodes too difficult to coordinate, Sarandos says. "The problem is logistics," he says. "They were all working full-time and doing this show in between, and they did it for the love of the show and for [creator] Mitch Hurwitz.
"If we can muster up that love again, we'd love to do it again.
Netflix will release all 15 episodes of the series simultaneously this Sunday at 3:15 a.m..


HTPCNews has a look at the lastest version of Snapstream Media's Beyond TV (3.5.1) software. The application allows you to record TV programming, with an appropriate TV tuner card of course, and manage your media files. The latest version of the software includes several enhancements which, apparently, makes it an even more attractive software package.


fetches, and a third external access to occur simultaneously with instruction execution.
processor is performing an external access for a previous instruction.
modified but has not been written back to external memory) for data in copyback pages.


Welcome back to another #trendytuesday! One of the biggest questions we get here on the blog is how to use those great Jillibean Soup Placemats! Today, I am sharing another video with you - a tutorial on how to fill and use the Hexagon Placemat layout.
Hope you were inspired to break out those placemats and get creating! Make sure you share your pages with us on our Facebook page!
Beautiful layout Nicole! Love it!
Thank you SO MUCH for the tutorial! It is appreciated!
I'm hoping to win the placemats from a previous post. Now I have a great idea on how to use them.
Incredible layout and tutorial. Love the placemats.


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Get an alert with the newest ads for Rideshare in Fort McMurray.
looking a ride to edmonton Sunday 21.
anyone going down to edmonton today? will pay for gas and help with the drive.
Looking for ride April 19- 22 from Fort Mac to anywhere between Kamloops and Revelstoke (Salmon Arm) can help with Gas, can help with driving, one way only.
Edmonton to Fort Mcmurray. This friday 12th.
Going back to Fort McMurray this Friday 12th before noon (we can agree on time). If anyone heading home, shoot me a text orbcall me on 581-994-2797 (Rika). (Gas contribution).
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text:
Home California Wine Maker Superhero: Angela Osborne as VIII Strength, Tarot's Major Arcana Woman...
Wine Maker Superhero: Angela Osborne as VIII Strength, Tarot's Major Arcana Woman in Tune
Angela Osborne as Tarot's Major Arcana VIII Strength
click on comic to enlarge
Understanding Tarot's Major Arcana
In Tarot the Major Arcana present a series of archetypes representative of stages of spiritual and personal growth or development. While the Minor Arcana (the same cards, basically, that we find in a standard deck of playing cards) indicate subtle processes that we can happen upon in any particular aspect of everyday life, the Major Arcana instead show a significant stage of a person's overall life. The stages offered through the Major Arcana are told as a kind of story of the Fool's Journey–the Fool being the fully open person guided by intuition with still a range of life experiences from which to learn. As the Fool (traditionally represented as a young man) moves forward on his life path he moves naturally through the growth processes of the Major Arcana (not necessarily in order) brought through the complexities of human life by his own choices and intuitive guidance both.
From this perspective, then, each Major Arcana can be understood as a sort of Jungian Archetype through which any of us may come to better understand tropes of human life and experience.
Superhero Archetypes
North American comic book superheros operate as a form of mythical archetype of the American psyche offering insight into our aspirations, fears, and stages of ethical development: Superman may stand as our cultures' desire for principled truth and goodness; Batman as recognition of our darker inclinations and our will to generate right action even in the face of them.
When considering comic book heroes and women archetypes, however, its easiest to just admit we've not done enough work to develop really rockin' women superheroes. They're often ridiculously big-boobed, cranky, or generally sexually problematic. (I do rather like Storm from X-Men, but notice she never really hooks up. Or, Phoenix Force, also from X-Men, but notice she just flat destroys the men she tries to love. It would seem it's hard to be a woman superhero AND happily in love. Though it actually seems men superheroes tend to have relationship trouble too. ANYWAY…) The point being, it can be hard to find an interesting range of superhero archetypes for channeling our favorite women wine makers through. With that in mind, I chose to look outside comic books to find the right figure for presenting Angela Osborne in her excellence. I find her, then, in one of the Major Arcana of Tarot.
Angela Osborne as Tarot's VIII Strength
Having moved through a discovery of his own passions and power to wield them, the Fool leaves his recent struggles journeying into the next stage of his life journey. Along the way he encounters a woman in the distance that would seem to be struggling with a lion. Determined to save her, the Fool rushes forward, bolstered by his own previous triumphes through struggle. He is certain he will wrestle the lion, risk his life and thus utilize his masculine bravery to save the beautiful feminine figure. As he approaches, the Fool discovers the woman merely petting the lion, the beast having calmed from her presence now still strong and wild but at peace with the woman's ease.
The Fool is confused. How could the lion relax its ferociousness to commune with the woman? And why would the woman wish to be so close to a beast? Compelled by the woman he asks her to explain. Without moving, the woman turns to the Fool and looks directly into his eyes. The Fool sees in her expression a great gentleness coupled with a calm certainty. In the combination he recognizes what would make the lion respond to her–she is in tune with her self in a way that allows her too to be in tune with her surroundings. It is not that she dominated the lion, but that she knew how to read and interact with the lion in a way that set it at ease. The Fool wishes to know what she would want with a beast. The woman reminds him that the lion is a unique energy with which there is much to experience and share.
(This version of the tarot story is largely thanks to aeclectic.net.)
Focused on honing her conscious awareness of what surrounds the wine she makes–both in the vineyards, and in the wine making facilities themselves, Angela Osborne presents a lived presentation of Tarot's Strength card. She cultivates her already deep respect for the wine through a commitment to bio-dynamic vineyard and wine making practices. Additionally, she relies on her own intuition of what the wine needs as it is being birthed in the barrel, along with a sense of surrender to what nature will offer beyond her own control. Together these elements show the grounded, centered, clarity of the feminine figure of Tarot's 8th Major Arcana, the Strength card.
We'll spend the next two days considering Angela Osborne's beautiful wines A Tribute to Grace, first through A Life in Wine story of how she came to making grenache, now alongside her husband Jason, then through a review of a complete vertical of the full Grace history.
Copyright 2012 all rights reserved. When sharing or forwarding, please attribute to WakawakaWineReviews.com
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Linnie Osborne Jul 2, 2012 At 4:26 PM
I enjoyed being devoured by your words whilst feeling the strength and power gently flow through me. You have an incredible gift of intuition and interpretation and have perfectly captured the essence of Angela's beautiful soul. Thank you and blessings
– aroha
A Life in Wine: Angela and Jason Osborne and A Tribute to Grace (and faith) | Hawk Wakawaka Wine Reviews Jul 3, 2012 At 1:58 PM
[…] If you're interested in seeing the previous post on Angela as the Wine Maker Superhero Justice VIII, you can view the post here: http://wakawakawinereviews.com/2012/06/30/wine-maker-superhero-angela-osborne-as-viii-strength-tarot… […]
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ARTIFICIAL INTELLIGENCE IN DIGITAL MARKETING.
MARKETING LEGEND SRINIDHI RANGANATHAN AWAITS..
to completely surge ahead of your competitors?
It's 2019, and you are busy browsing normal marketing websites of training institutes on google to join any digital marketing course in ANY digital marketing training instititue in Bangalore, India and you suddenly stumble upon http://www.firstlookai.com - India's First Artificial Intelligence Powered Digital Marketing Training Company. You try to research on our site to figure of what is AIDM (Artificial Intelligence in Digital Marketing) technology and how it can change the world altogether and redefine digital marketing to the core, and you suddenly are startled yourself seeing all this amazing technology.
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In today's competitive world, AI (artificial intelligence) impacts numerous aspects of life in the form of smart devices, virtual marketing assistants, virtual sales chatbots & virtual humans and self-driving cars. All of these are designed to understand consumer needs and preferences and they strive to deliver customised customer experiences that are the most advanced and futuristic.
Artificial intelligence (AI) used to be pure science fiction. But, now AI is science fact. This once futuristic technology is now implemented in almost every aspect of our lives and in marketing. The use of Artificial Intelligence (AI) in our digital marketing strategies is no different - whatsoever. Marketing taught everywhere (including digital marketing) is only practiced with traditional approaches and stuff people learn from Google. Unlike, Future 1.0 (India's First Digital Marketing Program powered by Artificial Intelligence) taught by Marketing Legend - Srinidhi Ranganathan, none of the other course or courses in the world will be able to cater to such a technology herein.
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WHY LEARN ARTIFICIAL INTELLIGENCE (AIDM) IN DIGITAL MARKETING?
It's time to bid goodbye to traditional marketing methods. Thanks to the biggest differentiator "Digital Marketing" which is creating new waves in the industry. If you are seeking a career in digital marketing or in the digital marketing industry - for that matter, there is absolutely no better time than now. If you are in Bangalore, then there's nothing to stop you from learning digital marketing. You can start getting trained in every topic of digital marketing. We were telling you that If you live in the silicon valley of India, you have too many choices to add to your bouquet to learn digital marketing. Here is a list of the top 10 digital marketing training institutes in Bangalore. These courses outlined and listed here will help you learn and master the craft of digital marketing to the core and some of them can get you placed at top companies also. Digital Marketing Companies require digital marketers who are adept in the topic of digital marketing fundamentals and advanced techniques fully. Typically Digital Marketing involves the art of SEO, SEM, SMM, SMO, Email Marketing, Inbound Marketing and vice versa. After gaining inspiration from Sorav Jain's Article Compilation on the "Top 21 Digital Marketing Training Institutes in Bangalore", we at First Look Digital Marketing Solutions Pvt. Ltd. have confidently went ahead to list down the top ones that create a mark - meaning create a difference in the ever-changing technological era in digital marketing. Digital Marketing is a booming phenomenon right now and many institutes have emerged in Bangalore. In fact, the use of Artificial Intelligence in Digital Marketing is now a widespread idea. Let's list out the benefits of learning digital courses in this field, typically.
There's 190,000 digital marketing jobs predicted by 2020 in India and there are not enough digital professionals to fill them. In Bangalore alone, there are a lot of marketing companies - startups, SMB's and MNC's who are into digital marketing and leveraging these mind-blowing digital technologies to their fullest potential. This provides those studying digital marketing courses with a unique competitive advantage – you're gearing yourself up for a career where demand exceeds supply. Always a good move it is to learn digital marketing and especially in Bangalore - it's a wow factor. Digital technologies who are researching and working on implementing these are becoming really popular. Some of the famous personalities in this digital marketing industry are Neil Patel, Ryan Holiday etc.
Remember this again: digital marketing companies still want your valuable skills – you might just need to turn them digital. Also in 2019, the demand for digital marketing professionals will rise by 50%. It's time you took advantage of this and learn courses in digital marketing by taking action NOW !
To kickstart your digital marketing career, also referred to as "data-driven marketing", through the use of digital technologies, it is important to join a good training course that focusses on the art and craft of leveraging digital marketing. Specifically on the Internet, but including mobile phones, display advertising, and other digital media, digital marketing classes and courses being conducted all over India is becoming the current trend. If you observed, you would see that digital marketing has been growing and being more competitive. Even the use of webinars for conducting digital marketing training courses is on the rise. There is no doubt that there is a huge number of digital marketing training courses in Bangalore - however, if you pick up an ineffective digital marketing course - you will tend to lose money and time. Before enrolling in a digital training course in Bangalore, make sure you talk to the right coach who will guide you to learn digital marketing in the best possible ways. Typically, it takes time, hard work and dedicated to learn and implement stuff taught in digital marketing training programs. After signing up for these digital training courses, it is important you practice on a whole range of marketing topics. Know one fact - Marketing cannot be taught to anyone who has no passion or interest to learn and implement digital strategies.
WHY WE SHOULD SEARCH FOR A BEST DIGITAL MARKETING TRAINING COURSE IN BANGALORE?
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The uproar of digital marketing training courses in the country has something to do with what their patronizers are getting from it. If you are a website or brand owner who is looking to employ different marketing strategy, you may want to consider digital marketing and applying digital technology to change the game altogether. To convince you on why you should go for it, here are the benefits that you should know, as digital is the new-gen stuff. Yes - we know it - before we read further - "The truth that machines are pretty much smart and becoming smarter day by day". Yes. Machines take in much less time to discover new opportunities and complete a job and also their functioning ability is even more greater compared to us. If Artificial Intelligence (AI) goes on to take control of the human tasks, there will certainly be a great turmoil. Additionally, if the creators of the machines which is us - go out of control or break the commands or if the tech we discover fall in the wrong hands, there could be a great deal of loss to all of us. However the bright side is that modern AI technology is a boon and leveraging it can change our lives for the better. Much - like we alter our old smart devices with the brand-new ones regularly. So, with the development of modern technology, the needs of people will certainly increase and also with Artificial Intelligence we will certainly develop more and more AI tools as well as utilize it to the full extent of functionality.
To conclude with, the great little bits of AI are unbelievable, significant company titans around the world are producing overwhelming applications based upon AI catered to every industry including marketing, HR, Retail, Automobile, Construction, Real-Estate etc.These are no question wonders and also we could go on utilizing them for our future, unlike relying on traditional technology to aid in our success path. I simply can sum everything up in one sentence or even one word - perhaps. "Automation"..
Well! you're almost there at the end and there's no reason to consider yourself unfit. If you need to succeed online with learning digital marketing, content and intensive online research must come to you either naturally or by practice. Most of the business professionals learn digital marketing by practice - through implementing the tricks, tips, techniques taught and a very few do it naturally.
You must have a knack for research conducted through digital platforms and an eagle's eye for what's trending on the world wide web and what others are doing. Most importantly, uou must know what people are looking for. This is the key. This is how digital tech-savvy people are born.
Tools and digital techniques can be learnt anytime. SEO, Social Media, Web Analytics, Email, Content everything can be learnt if you are passionate and keen about them. Now, when it comes to learning digital marketing with focussing on Artificial Intelligence - we at FirstLookAi have some incredible digital technology that none has in the country. In fact - only two people in the world have this technology we are talking about - which you can check out in the home page. Have a look at out this Udemy course on "Artificial Intelligence Website Creation" - anytime when free.
If you are keen about learning and researching from the online space or Google or through leveraging any other digital technologies and medium - then there are enough good resources available online but you will definitely have a hard time in figuring out the most relevant ones and updated ones as Internet is highly dynamic and search and social keep changing their algorithms every now and then. We have done 4+ years of research in Artificial Intelligence Powered Digital Marketing Principles. If you are ready to roll and skyrocket your career with hands-on stuff rather than learning powerpoint (ppt) presentations or old and outdated digital technologies and we will show you the future of Artificial Intelligence Technology in Digital Marketing and you'll never ever leave us.
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If you are thinking of having a go at looking to learn digital marketing and absolutely mastering the craft, there's no better time than now. Our digital marketing training programs are the most engaging ones and we go a long way to help students by moulding them to the right track to take the action steps to aid in their career. The need for digital marketers is everywhere – which goes without saying that the industry offers plenty of opportunities that will help you grow career-wise. In plain words, Digital Marketing is booming and you are just one step away from choosing the right move to surge ahead in your career path. Who knows? You may even be known to the media if you apply certain tricks, tips and follow the walkthrough tutorials after attending the course.
WHY WE THINK DIGITAL MARKETING WITH ARTIFICIAL INTELLIGENCE CAN CHANGE THE WORLD, FOR THE BETTER?
The blog articles of the best DIGITAL MARKETING influencer's in the world like Neil Patel for example (http://www.neilpatel.com), magazine features and tabloid news stories featured in Google News now talk about AI (Artificial Intelligence) as a new-age ultra-phenomenon that is going to change everything completely. This mind-blowing stuff is completely true. AI has the power to change our lives for the better and revolutionize the way we interact with the world around us.
Talk about Artificial Intelligence in Advertising & Marketing - the entire experience will be tailored to the recipient to ensure every ad is relevant, personalized just like billboards on roadsides, designed to make your audiences ponder. They can be more focused on delivering ads to people, with less guesswork. With AI, marketers will be able to understand consumers on an intricate level. It just won't just personalize content, in fact - it will allow consumers to provide instant feedback, ask questions about your products/services and take advantage of special offers through interaction with the AI. This is possible with the rise of chatbot creation platforms like http://www.chatfuel.com that can be integrated in Facebook messenger platforms. Also, with AI, ads can be personalized to a far greater degree and instantly delivered to users based on a qualified profile shot of their entire browsing history.
If you want to learn about these amazing AI technologies in a classroom environment with a virtual robot Aera and Marketing Legend Srinidhi Ranganathan - why not enroll as a student at http://www.firstlookai.com (India's First Artificial Intelligence Powered Digital Marketing Company)? With Artificial Intelligence incredible & wow inspiring stuff are possible to do..
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text:
HICKEY AND MCGEE LOVE BOOKS
crime, wisdom, humor
H & Mc Booksellers
H & Mc Outlet
MIDHEAVEN
Ken Kuhlken's first novel, originally published by Viking Press, has since become a companion to the Hickey family crime series and Book 1 in the three book epic love story, Hickey and McGee.
The haunting story, honored as a Finalist for the Ernest Hemingway Award for Best First Fiction Book, set in and around the exquisite Lake Tahoe basin, is told by a precocious seventeen-year-old torn between her quest for God and her love for a man.
During the early 1970s, in a paradise fast becoming a millionaires' playground, a high school senior, troubled by her father's gambling and the arrogance of her wealthy peers, turns from drugs and boys to radical Christianity. But when she falls for her English teacher, a gambler and dedicated unbeliever, hard choices test her will, her faith, and her love. And tragic results threaten her sanity.
Anne Tyler, as Chair of the Ernest Hemingway Award selection committee, wrote, "The pace, clarity and assurance of Midheaven make it a pleasure to read."
From Kirkus Reviews: "Kuhlken has, with Jodi, created a character new to us–the born again adolescent who's in-the-know–and he provides her with grit and honesty."
Novelist Andy Straka commented, "Midheaven is one of those rare gems of a novel that sneaks up on you and nestles in your soul. I especially enjoyed the setting and character development. The sun-dappled mountains and cold water beauty of Lake Tahoe hold too many secrets for a teenage girl to bear. Jodi is a character you won't soon forget."
Midheaven is available in trade paper and ebook.